Dr. Tom Ryan:

The buck has to stop somewhere in the health care system. Somebody has to be accountable for the quality of patient care provided. Currently, it is consultants who take that responsibility every day and they need to be supported.

The non-consultant hospital doctor, NCHD, and nurse recruitment process is a HR disaster. The HR system in the HSE regards health care staff as a liability, not as an asset, and treats them as such. That is why we cannot recruit or retain staff in the health care system.

As to when one should admit there has been a problem and who should be in the room, very often one has to continue caring for the patient whom one may have just harmed. One has to maintain that patient’s trust. If the patient in any way senses one is prevaricating, obfuscating or being less than open, one loses his or her trust and the atmosphere becomes poisonous. One has to be honest, open and upfront as early as possible. Sometimes the details of what has happened are confidential to the nurses and doctors looking after the patient and it would be inappropriate to have an administrator in the room. However, the admission has to be made early, open, full and honest, but one has to maintain the trust of the patient. If one is open and honest with the patient and apologises when something has gone wrong, one will not be sued. There will be no litigation. All the patient will want is an apology and some guarantee the same adverse event will not happen again in the future. There will, however, be implications for the health care system of such openness and honesty. One implication will be there will be a need to have more resources focused on the front line and more clinical governance of the system.